Module 3: Breaking Bad News & Difficult Conversations
These are the stations most candidates dread, and where the strongest candidates shine. What separates them is not courage. It is structure. Every conversation in this module, however emotionally demanding, has a framework that keeps you clear, compassionate, and in control.
Module Introduction
| Lesson | Core Skills |
|---|---|
| 3.1 — SPIKES and Bereavement | Use SPIKES: Setting, Perception, Invitation, Knowledge, Emotions, Strategy. Respond to emotion before moving to strategy. 'Died' not 'passed away' in the opening delivery. |
| 3.2 — Unwanted Results and Chronic Diagnoses | Check what they know first. Acknowledge emotion before explaining. Offer genuine hope where it exists. Specific phrasing for T2D, CIN, HIV, and incidental findings. |
| 3.3 — Counselling Stations | Use for counselling stations: Step 1 Clarify the concern → Step 2 Assess background → Step 3 Reassure and explain → Step 4 Engage in shared plan. Always understand before you explain. |
| 3.4 — Angry Patients and Self-Discharge | Acknowledge first, always. Never defend while the patient is in the emotional phase. Self-discharge: confirm capacity, explain specific risks, respect the decision, document, safety-net. |
| 3.5 — Relatives and Third Parties | Duty is to the patient. Share only with consent or under a recognised exception. Use professional interpreters — never family members for clinical translation. |